問題一覧
1
1 twitch =
90% blocked
2
what nerve to use during maintenance of NM blockade:
ulnar
3
when single twitch stimulation is used:
used to time onset of neuromuscular block in prep for Tracheal intubation
4
rebreathing will be noticed in what phase:
I- baseline elevation, should be 0 normally also with co2 absorbent exhaustion and faulty expiratory valve
5
most sensitive to NM blockers:
adductor pollicis
6
advantage of liquid crystal temp monitoring:
cheap, easy to apply, noninvasive, safe, useful for regional/MAC cases
7
disadvantage to rectal temp:
slow response to change in core body temp
8
the surgeon may not have sufficient abdominal muscle relaxation even though the ______ nerve is blocked
ulnar
9
features of nerve stimulator:
maintain current for duration of impulse battery power charge indicator low battery alarm high output/low output sockets audible signal with each stimulus mult patterns of stimulation
10
AANA standards for monitoring: 6 things:
ventilation oxygenation circulation temperature neuromuscular function positioning
11
what phase of capnography would be evident of CO2 absorbent exhaustion:
I
12
routine monitors of deferral anesthesia: 3
oxygen analyzer, capnography, end-tidal agent monitor
13
prolonged (less steep) upstroke of phase II would indicate: select 3
mechanical obstruction , COPD, bronchospasm
14
TOF stimulation:
4 separate supramaximal stimulus 0.5 sec at 2 Hz for 2 seconds
15
monitors are useless unless you are
vigilant
16
conduction
direct transfer of heat between patient and surface they are in contact with (3% of temp loss)
17
Phase III of capnography: select 3
horizontal with mild upslope , CO2 rush alveolar air , represents maximum CO2 at end of phase
18
esophageal probe:
best combo of cost, performance and safety placed in lower (distal) 1/3 of esophagus accurate core body temp
19
5 standards for oxygenation
continuous pulse ox with variable pitch tone continuous auscultation continuous clinical observance O2 analyzer and low O2 concentration alarm disconnect alarm on vent
20
tympanic temperature reflects what temp?
brain
21
02 analyzer location and what it does
inspiratory limb of circuit and measures fiO2
22
used to time onset of neauromuscular block in prep for tracheal intubation:
single twitch
23
resistant to NM blockers:
orbicularis oculi
24
3 electrode system EKG, which lead is best to detect p waves and NSR
II
25
3 twitches =
75% blocked
26
PaO2 of 40 = SaO2 of
75
27
detects anterior and lateral wall ischemia
V5
28
how often to chart TOF:
frequency is agent specific
29
convection
surface area of skin exposed and velocity of air passing over skin determines kcal/hour lost (12% of loss)
30
wait until at least ______ response to TOF is obtained before attempting reversal.
1
31
how BIS works:
raw eeg obtained through sensor placed on forehead 0-100 direct measure of patients consciousness goal 40-60
32
evaporation
as water evaporates, 0.6kcal/gram lost, 25% of heat loss
33
true regarding this photo:
CO2 absorbent exhausted , EtCO2 does not return to baseline 0
34
Phase I of capnography: select 3
corresponds to dead space ventilation , CO2 should be zero unless rebreathing occurs , fresh gas moves over the sampling site
35
deoxygenated hemoglobin absorbs:
visible red at 660
36
ulnar nerve monitoring: contraction of what muscle:
adductor policis
37
verify intubation by: 3
auscultation, positive chest excursion, expired co2
38
nerve in face to stimulate
orbicularis oculi
39
Tetanic Stimulation:
rapid delivery of stimuli- sustain muscle tetanus without fade 50 Hz for 5 seconds 50% of receptors can still be occupied assess residual muscle relaxant if contraction is held for 5 seconds without fade then significant paralysis is unlikely precense of fade: >75% of receptors are blocked no fade = correlates with the ability to protect airway after intubation
40
NIBP disadvantages: 6
leaning on cuff, shiver, motion, site limitation, trauma, not continuous
41
continuous auscultation: ultilizes what 2 items
precordial or esophageal stethoscope
42
what 3 leads are 98% sensitive to detecting ischemia:
II, V4, V5
43
used to assess residual muscle relaxant:
tetanic
44
PaO2 of 60 = SaO2 of
90
45
who first introduced standards for monitoring ?
AANA
46
temperature of fibrillatory:
< 32 C
47
factors with no effect on pulse ox:
bilirubin, HbF, HbS, flourescein dye, acrylic nails
48
loss of plateau might indicate:
COPD, asthma, bronchospasm, mechanical obstruction
49
which single lead best detects ischemia:
V5
50
the response of the nerve to electric stimulation of TOF depend on 3 factors:
current appplied duration of current position of electrodes
51
oxygenated hemoglobin absorbs:
infrared at 940
52
last muscle to show residual blockade:
adductor pollicis
53
advantages to precordial stethoscope
noninvasive, cheap, easily detect changes in breath and heart sounds - ex: airway disconnect, anesthesia depth, endobronchial intubation
54
Q-R=
alveolar ventilation
55
gold standard for cardiac evaluation:
transesopheal echocardiography TEE
56
correlates more closely to the other central muscles for determining NM block onset:
orbicularis oculi
57
radiation
heat loss proportional to thermal gradient between patient and OR room temp (accounts for over half of intraop heat loss) MOST
58
preferred nerve to stimulate to determine NM blockade
ulnar
59
nerve to use for intubation
orbicularis oculi
60
offers best combination of cost, performance and safety in regards to temperature monitoring:
esophageal probe
61
R-S=
inhalation (pure fresh gas)
62
benefits of esophageal stethscope 2
excellent quality fo breath and heart sounds accurate core body temp
63
capnography meansure amount of CO2 present in the circuit at:
end expiration
64
what does carboxyhemoglobin do to pulse ox:
absorbs light identical to oxyhemoglobin and will give falsely high reading pulse ox
65
how much temp can body lose per hour?
0.5-1 C
66
esophageal stethoscope 4
long plastic tube like device placed into esophagus by oral or nasal route once inserted, adjust depth until heart sounds are loudest distal 1/3 of esophagus ONLY in general anesthesia
67
what phase of capnography would be evident of incompetent expiratory/inspiratory valves:
I
68
phase III steepness =
expiratory resistance
69
disadvantages to tympanic temp:
potential for membrane perforation
70
R =
max CO2
71
which lead combo is best for detecting ischemia:
II and V5
72
CO2 undergoes transformation and is carried in:
RBC
73
cerebral oximetry: provides what value and what does it mean
regional oxygen saturation or rS, typically around 70% values below 50% suggest decreased cerebral oxygenation
74
PaO2 of 30 = SaO2 of
60
75
CO2 level with embolism:
low
76
identifies right mainstem intubation
precordial stethscope
77
beer lamberts law:
relates intensity of light through a substance, blood, and concentration of dissolved solute, hemoglobin
78
Phase II of capnography: select 2
early exhalation/ steep upstroke , quick mixing of dead space with alveolar gas
79
first to be blocked soonest:
diaphragm
80
factors affecting pulse ox accuracy:
ambient light, patient movement, shiver, hypothermia, low CO, dyshemoglobinemias: methemoglobin (falsely low) and carboxyhemoglobin (false high), injected dyes
81
why is radial artery most commonly used for a lines:
dual blood supply
82
what will get blocked first:
larynx
83
5 circulation standards
1. BP/HR q5min 2. continuous ekg 3. continuous pulse ox 4. continuous auscultation 5. digital palpitation
84
temperature of hypothermia
< 36 C
85
liquid crystal temperature monitoring:
Mylar strips of liquid crystals, temp variations change molecular arrangement, reflects temp accordingly
86
most accurate in determining fade:
double burst
87
clinical application of capnometry: 5
metabolism (MH, hypothermia) circulation (CPR adequacy, embolism) respiration (apnea, hyper/hypo ventilation, confirm ETT) breathing system (absorbent, unidirectional valves) correlation with PaCO2 (1-6mmHg range- not if dead space or VQ mismatch)
88
double burst stimulation: 4
2 tetanic stimuli at 50 Hz with 0.75 sec pause response to each burst is perceived as a single muscle contraction more accurate in determining fade does not exclude residual NM blockade
89
core temperature prob locations:
pulmonary artery, distal esophagus, tympanic membrane, nasopharyngeal
90
BIS can help prevent:
awareness
91
V5 (brown lead) benefit and location
5ICS/ left anterior axillay line…detect anterior and lateral wall ischemia
92
best nerve stimulation pattern to determine FADE
double burst 50Hz with .75sec pause perceived as a single muscle contraction
93
esophealgeal stethscope: placement and 2 advantages:
balloon covered distal opening with temp probe, placed IN DISTAL 1/3 of esophagus in ANESTHETIZED patients…excellent quality of breath and heart sounds, accurate core body temp
94
standard for neuromuscular function:
continuous monitoring when blocking agents are used TOF documentation frequency is agent specific
95
2 things:
curare cleft: sticking of inspiratory valve or spontaneous breathing on vent
96
CO2 absorbent exhausted will cause a _______ rise in EtCO2?
gradual
97
0 twitches =
95% blocked
98
central muscle compared to peripheral muscles and NM blockade:
central are less sensitive and recover faster peripheral are more sensitive and recover slower
99
what phase of capnography would be evident of Bain circuit flows too low:
I
100
4 twitches =
less than/ equal to 70% blocked